MEDICARE: TEAM CLINICS AH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1821506528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEAM CLINICS AH LLC

Provider Business Mailing Address
First Line	:	3112 COOKE WAY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73179-2401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3112 COOKE WAY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73179-2401
Country	:	US
Telephone Number	:	405-600-6869
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TREVOR NUTT
Credential	:
Telephone Number	:	405-546-4130

Provider Enumeration Date	:	01/16/2018
Last Update Date	:	06/28/2021

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Directions to “TEAM CLINICS AH LLC ” Practice Location

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